Higher-Calling.com Group Agreement
Client name:_________________________
This document represents an agreement between you (“you” or “client” signed below) and Jayson L. Graves of Healing for the Soul Counseling & Coaching, LLC, Higher-Calling.com, a ministry of Pure Community Ministries, Inc. and their agents (“HFTS/HC”). By signing this agreement initially as a visitor, you only agree to the confidentiality portion herein; the agreement is activated in terms of commitment when payment is received. The following represent the covenants for the teleconference coaching group known as “Higher Calling Teleconference Group,” by which all parties abide: It is understood that the group is confidential and you give permission to the team members of HFTS/HC to consult with each other about your personal issues and group involvement. HFTS/HC also agrees to protect clients’ confidentiality. Exceptions to confidentiality occur with the following, HFTS/HC would report such information to appropriate authorities: • • • • • • If you pose a serious physical danger to yourself or another person; If you disclose information indicating threats to national security; If you disclose that you or another person have physically or sexually abused or molested a child/minor, and incompetent person, or a disabled person; If you disclose that a child, an incompetent person, or a disabled person is suffering from neglect; Subpoenaed testimony in criminal court cases, and orders to divulge information by judges in child-custody and divorce court cases; If criminal or delinquency proceedings occurred; if there is a legal or disciplinary proceeding regarding quality of services provided, or if services are being reviewed by a professional or legal entity;
1. You agree to complete The 12 Steps and may “graduate” from group whenever fulfilled. You agree to complete and present each Step of the workbook individually to the group and give HFTS/HC 2-weeks’ notice before graduating from group. This is the main commitment to the group. Premature departures are prohibited and clients commit, regardless of circumstances to complete and present the Steps before properly graduating out of group. 2. The fee for the group is $84 (@ 60 minutes/week) or $104 (@ 90) per month. Fees are billed prior to the first official group meeting for up to the first quarter and in quarterly installments, thereafter ($252 or $312 respectively). (Monthly payment and budget plan options also available upon request; fees and all terms of this agreement subject to change—see HFTS website for the most current agreement). 3. Depending on number of members, the group time will flex month-to-month between 60:00 and 90:00. Therefore, monthly credits or adjustments will be made according to how you were previously billed. 4. A $200 refundable deposit is also charged at the time of joining and will be refunded upon proper graduation from group as defined in “1” above. If, for any reason, this commitment is broken prematurely (before finishing and presenting all 12 steps from the workbook), or you are dismissed for cause such as breach of confidentiality, lack of commitment, conduct detrimental to the group (as decided by Facilitator), etc., you may be required to forfeit balance of current term and/or deposit as a protective measure to those in the group and deterrent from laxity. Initials: ___________
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(Continued from page 1) 5. The groups are not “drop-in” style and therefore, weekly attendance is expected and maintained by all except in cases of family/work emergency (“something urgent and unplanned”), whereby the you will directly contact Facilitator or a group member before the meeting. Repeated violations of attendance agreement may result in termination from the group. There are no refunds for missed meetings. 6. Each week the client will receive quantitative and qualitative feedback from the other group members and will consider and apply this feedback appropriately as he progresses through “The 12 Steps: a Spiritual Journey” workbook which must be purchased prior to the first meeting ($22, Priority postage included). 7. You are welcome to continue after completing the material so long as they are active in their recovery and come to an agreement with facilitator vis-à-vis material to be used post-completion of the initial curriculum. This agreement shall govern any such continuation but is subject to change at any time. 8. You agree to maintain a minimum monthly commitment to individual therapy or coaching with either a HFTS staff member or outside therapist for the duration of their commitment. This may include Jayson Graves, or a colleague at a frequency of at least once per month. If client chooses a therapist or coach outside HFTS, client agrees to sign a Release of Information form (see Resources/forms page of the HFTS website) allowing facilitators to communicate with each other in order to serve client as a team. “I agree to and fully accept the above terms of this covenant (page 1 attached).” Client signature: ____________________________ Print: _____________________________ Phone #: ____________________________________________________________________ Mailing Address: ______________________________________________________________ Email Address: _______________________________________________________________ “I understand the terms of this agreement & will support my group and spouse to fulfill them completely.” Spouse signature (preferred unless client is single/divorced): ___________________________________________________________________________ [Please fax to 719-325-7057 along with Disclosure Statement (http://www.healingforthesoul.org/pdf/Disclosure%20Statement.pdf). Then email info@healingforthesoul.org or call the office at 719-590-7685 for teleconference call-in information].
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